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Transcranial Doppler Ultrasonography: Clinical and Diagnostic Utility

Evidence supports using TCD in evaluating certain cerebrovascular conditions.

Transcranial Doppler (TCD) ultrasound noninvasively measures blood-flow velocity and direction in the basal cerebral arteries. This report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) summarizes the clinical utility of TCD and transcranial color-coded sonography (TCCS) for the evaluation and management of patients with specific cerebrovascular conditions. This report is based on a review of literature through June 2003, including summary statements and selected articles that reflect a mixture of diagnostic, therapeutic, and prognostic information. The authors were specifically interested in determining (1) whether the evidence shows that TCD provides useful information in specific clinical settings, (2) whether this information improves patient outcomes, and (3) whether TCD is preferable to other diagnostic tests in these clinical situations.

The authors concluded that TCD is of established value in two clinical settings: (1) screening children ages 2 to 16 years with sickle cell disease for stroke risk, and (2) detecting and monitoring angiographic vasospasm after spontaneous subarachnoid hemorrhage (SAH). However, more data are needed to show whether TCD affects clinical outcome in this setting. Other clinical conditions for which TCD and TCCS may provide important clinical information include intracranial occlusive disease, vasomotor reactivity testing, brain death, right-to-left cardiac or extracardiac shunts, traumatic SAH, extracranial internal carotid artery occlusion, and monitoring of carotid endarterectomy, cerebral thrombolysis, and coronary artery bypass grafting.

Comment: This important analysis clearly establishes the clinical utility of TCD in its current state of development. The authors should be commended for their rigorous, robust literature review. This technology is inexpensive and noninvasive, has a low risk profile, and is easy to use at the bedside with the potential for continuous monitoring, making it a highly desirable diagnostic tool. We can anticipate that future research on contrast-enhanced TCD/TCCS will significantly expand the clinical utility of these techniques for the diagnosis and management of patients with cerebrovascular disease.

— Farzaneh A. Sorond, MD, PhD

Dr. Sorond is Associate Neurologist, Brigham and Women's Hospital, and Instructor in Neurology, Harvard Medical School, Boston.

Published in Journal Watch Neurology October 8, 2004

Citation(s):

Sloan MA et al. Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004 May 11; 62:1468-81.

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